Yes

Alpha/Beta Agonist

Treatment of bronchial asthma, nasal congestion, acute bronchospasm, idiopathic orthostatic hypotension

C

Hypersensitivity to ephedrine or any component, cardiac arrhythmias, angle-closure glaucoma, patients on other sympathomimetic agents

Blood volume depletion should be corrected before ephedrine therapy is instituted; use caution in patients with unstable vasomotor symptoms, diabetes, hyperthyroidism, prostatic hypertrophy, or a history of seizures; also use caution in the elderly and those patients with cardiovascular disorders such as coronary artery disease, arrhythmias, and hypertension. Ephedrine may cause hypertension resulting in intracranial hemorrhage. Long-term use may cause anxiety and symptoms of paranoid schizophrenia. Avoid as a bronchodilator; generally not used as a bronchodilator since new beta₂ agents are less toxic. Use with caution in the elderly, since it crosses the blood-brain barrier and may cause confusion.

>10%: Central nervous system: CNS stimulating effects, nervousness, anxiety, apprehension, fear, tension, agitation, excitation, restlessness, irritability, insomnia, hyperactivity

1% to 10%:

Cardiovascular: Hypertension, tachycardia, palpitations, elevation or depression of blood pressure, unusual pallor

Central nervous system: Dizziness, headache

Gastrointestinal: Xerostomia, nausea, anorexia, GI upset, vomiting

Genitourinary: Painful urination

Neuromuscular & skeletal: Trembling, tremor (more common in the elderly), weakness

Miscellaneous: Diaphoresis (increased)

<1%: Chest pain, arrhythmias, dyspnea

Symptoms of overdose include dysrhythmias, CNS excitation, respiratory depression, vomiting, convulsions

There is no specific antidote for ephedrine intoxication and the bulk of the treatment is supportive. Hyperactivity and agitation usually respond to reduced sensory input; however, with extreme agitation, haloperidol (2-5 mg I.M. for adults) may be required. Hyperthermia is best treated with external cooling measures; or when severe or unresponsive, muscle paralysis with pancuronium may be needed. Hypertension is usually transient and generally does not require treatment unless severe. For diastolic blood pressures >110 mm Hg, a nitroprusside infusion should be initiated. Seizures usually respond to diazepam I.V. and/or phenytoin maintenance regimens.

Decreased effect: Alpha- and beta-adrenergic blocking agents decrease ephedrine vasopressor effects

Increased toxicity: Additive cardiostimulation with other sympathomimetic agents; theophylline cardiostimulation; MAO inhibitors or atropine may increase blood pressure; cardiac glycosides or general anesthetics may increase cardiac stimulation

Protect all dosage forms from light

Releases tissue stores of epinephrine and thereby produces an alpha- and beta-adrenergic stimulation; longer-acting and less potent than epinephrine

Oral:

Onset of bronchodilation: Within 0.25-1 hour

Duration of action: 3-6 hours

Distribution: Crosses the placenta; appears in breast milk

Metabolism: Little hepatic metabolism

Half-life: 2.5-3.6 hours

Elimination: 60% to 77% of dose excreted as unchanged drug in urine within 24 hours

Children:

Oral, S.C.: 3 mg/kg/day or 25-100 mg/m²/day in 4-6 divided doses every 4-6 hours

I.M., slow I.V. push: 0.2-0.3 mg/kg/dose every 4-6 hours

Adults:

Oral: 25-50 mg every 3-4 hours as needed

I.M., S.C.: 25-50 mg, parenteral adult dose should not exceed 150 mg in 24 hours

I.V.: 5-25 mg/dose slow I.V. push repeated after 5-10 minutes as needed, then every 3-4 hours not to exceed 150 mg/24 hours

Blood pressure, pulse, urinary output, mental status; cardiac monitor and blood pressure monitor required

Can cause a false-positive amphetamine EMIT assay

Nervousness, anxiety, agitation, restlessness, and insomnia are common

Use with MAOIs may produce hypertensive crisis; avoid combination

Use vasoconstrictors with caution since ephedrine may enhance cardiostimulation and vasopressor effects of sympathomimetics such as epinephrine

No effects or complications reported

Use this medication exactly as directed; do not take more than recommended dosage. Avoid other stimulant prescriptive or OTC medications to avoid serious overdose reactions. Store this medication away from light. You may experience dizziness, blurred vision, restlessness (use caution when driving or engaging in tasks requiring alertness until response to drug is known); or difficulty urinating (empty bladder immediately before taking this medication). Report excessive nervousness or excitation, inability to sleep, facial flushing, pounding heartbeat, muscle tremors or weakness, chest pain or palpitations, bronchial irritation or coughing, or increased sweating. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Breast-feeding is not recommended.

Do not administer unless solution is clear

Capsule, as sulfate: 25 mg, 50 mg

Injection, as sulfate: 25 mg/mL (1 mL); 50 mg/mL (1 mL, 10 mL)

Jelly, as sulfate (Kondon's Nasal®): 1% (20 g)

Spray, as sulfate (Pretz-D®): 0.25% (15 mL)

Pickup ME, May CS, Sendagire R, et al, "The Pharmacokinetics of Ephedrine After Oral Dosage in Asthmatics Receiving Acute and Chronic Treatment," Br J Clin Pharmacol, 1976, 3(1):123-34.

Stein GC, "Requirements for Pharmacists Dispensing Ephedrine Products," Am J Health Syst Pharm, 1995, 52(15):1630.